Doctor Pleads Guilty in Connection with Medicare Psychotherapy Fraud Scheme

A Detroit doctor at the center of a $13.2 million psychotherapy fraud scheme, which used the Medicare information of mentally-disabled Detroit residents to defraud Medicare, pleaded guilty today for his role in the scheme, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Robert D. Foley, III of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh, III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Chicago Regional Office.
Dr. Alphonso Berry, 51, of Orchard Lake, Michigan, pleaded guilty before U.S. District Judge Stephen J. Murphy, III in the Eastern District of Michigan to one count of conspiracy to commit health care fraud and five counts of health care fraud. Marcus Jenkins and Beth Jenkins, Dr. Berry’s co-conspirators in the scheme, pleaded guilty on January 7 and January 3, 2012, respectively, to the same charges for their roles in the scheme.
Dr. Berry admitted that he and others conspired to defraud Medicare through Quality Recreation & Rehabilitation LLC (QRR) and Procare Rehabilitation Inc., two Detroit adult day care centers. Dr. Berry admitted that he created a Medicare provider number for these businesses to allow them to bill Medicare for psychotherapy in his name. According to court documents, the Medicare recipients at QRR and Procare were severely mentally-disabled residents of Detroit adult foster care homes. Dr. Berry admitted that, although he did not provide any psychotherapy to these patients at QRR and Procare, he signed psychotherapy progress notes that were used at these companies to submit psychotherapy claims to Medicare, including claims that he provided psychotherapy to a dead person.
Court documents allege that Dr. Berry and his co-conspirators used Dr. Berry’s Medicare number to submit more than 116,000 psychotherapy claims in his name, amounting to more than $8.2 million. From 2004 through 2011, QRR and Procare submitted more than 185,000 claims to Medicare totaling more than $13.2 million for group and individual psychotherapy that was not provided. According to court documents, Medicare paid $4,777,792 on these claims.
At sentencing, scheduled for April 26, 2013, Dr. Berry faces a maximum penalty of 60 years in prison and a $1.5 million fine.
This case is being prosecuted by William G. Kanellis and Tarek Helou of the Criminal Division’s Fraud Section. It was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.